The longer you use opioids, the greater the risks—and the risks rise fast.

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The longer a person uses opioids, the greater the risk of forming a deadly addiction. But just how long does it take to switch from being a short-term user—say, while you’re dealing with pain after a surgery—to a long-term, potentially problematic user? A few weeks? A month?

According to a new study, that transition could take just a matter of days.

When patients get an initial opioid prescription that’s just a one-day supply, they have about a six-percent chance of being on opioids for a year or longer. But if that first prescription is for a three-day supply, the probability of long-term use starts inching up. With an initial five-day supply, the chance jumps to about 10 percent. With a six-day supply, the chance hits 12 percent. With 10-day’s worth, the odds of still being on opioids a year later hits roughly 20 percent.

So, with an initial 10-day opioid prescription, about one-in-five patients become long-term users. That’s according to the new study’s lead author Bradley Martin, a professor of pharmaceutical evaluation and policy at the University of Arkansas for Medical Science. It’s a fast rise, Martin said to Ars. “We really didn’t expect that.”

And, according to the rest of the data—published Friday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR)—things just keep getting worse from there.

Further Reading

To calculate the probabilities, Martin and his colleagues tracked the prescription records of nearly 1.3 million patients. Those patients were all 18 or older, cancer-free, and got at least one opioid prescription between June 2006 and September 2015. They also didn’t have any history of opioid abuse.

For patients who get a 30-day stash of opioid all at once for their initial prescription, the chance of being on opioids for a year rose to 45 percent. But, Martin says, getting that much in one go is uncommon. Only about seven percent of patients get such long-duration prescriptions in the study. Most people get about a week’s worth at a time.

People who got 30 days of opioid total—meaning they may have gotten multiple prescriptions or refills over time—had about a 30-percent probability of using opioids for a year. And they had a nearly 20-percent chance of being on them for three years.

Further Reading

Other factors that kicked up the chances of long-term use were long-acting opioids, getting a cumulative dose equivalent to more than 700 milligrams of morphine, and getting multiple prescriptions. One in seven who got a second opioid or a refill were on the addictive drugs for at least a year.

Martin says he hopes the fresh data will help prescribers make smart and informed choices when doling out the powerful drugs. Early last year, the CDC released guidelines for prescribing opioids, recommending weak, short doses, ideally three days for acute pain. The agency urged doctors to refrain from prescribing opioids for chronic pain, except for cancer patients and end-of-life care.

In the study, Martin and colleagues found that less than one percent of patients were prescribed powerful, long-acting opioids, which are used for chronic pain. This suggests that intentional chronic pain prescriptions are uncommon. But the authors did note that 10 percent of patients got tramadol, which is considered a relatively safe opioid. So this may hint that some intentional prescriptions for chronic pain is going on.

The CDC estimates that 91 people die of an opioid overdose every day in the US.

347 Reader Comments

I noticed that a lot of the comments were from people who had never experienced severe excruciating pain nor had they taken the pain pills in question...i just wanted to add a dose of reality to the comments.

It would be refreshing to see a story about the people who benefit from this drug instead of yet another one demonizing it; oh, and better science would be good.

This isn't about demonizing opioids.It's about studying how frequent/easy it is for patients to become addicted to them.A rough summary would be: If you're prescribed ~10 days of opiod based pain killers (eg, after a surgery or something like that) you've got a 20% chance of becoming addicted to them.The logical conclusion would be that opiod prescription need to done judiciously and those patients need to be followed upon to track and treat possible addictions.

Too many doctors are forgetting that people are taking these opioids primarily for ACTUAL pain. Just yanking people off the medication or drastically reducing dosage with no form of dependence assistance is only making the problem worse and increasing suffering.

I dont mean to make you feel bad by criticizing two posts in one article, and I acknowledge your post is made in good faith. That said you're missing the bigger picture.

Policy is often thwarted by poltics. For example many people believe there is a moral imperative and that losers who don't know any better should be kept away from the evil of opiates by laws that protect them from their own weak character.

Ideally opiate policy would simply optimize for saving lives and not try to sort out who is a loser because they took some pills. Decriminalization should be researched from a utilitarian point of view.

20,000 people died last year due to opiates. What would that number be if policy focused only on harm reduction and not punishment?

We can start with the fact that a large number of those deaths are directly linked to addicts being forced into a game of russian roulette with impure and unpredictable street drugs.

If this were only about saving lives, economists and doctors would work together to estimate the number of deaths under all policy options including legalization + harm reduction.

I have no dog in this fight. I'm not a drug dealer, not big pharma, and this is not some kind of principled stance on personal freedoms. Just use the best science available to determine what policy allows the most people to live. So far that hasn't been done. Let the chips fall where they may.

I read the thread with great interest but I struggle to find a policy recommendation that would get a majority of discussants on board. Of course, we could just say to leave the current framework in place.

One minimal approach would be to distinguish between short-term pain events and chronic or terminal pain.

The former case covers fractures, orthopedic injuries etc where pain can be intense but it also generally subsides after a few days or weeks. It seems to me that the risk of addiction is never worth the superior pain killing abilities of opiates in this case.

For chronic pain management, the costs and benefits seem more complicated. But a prohibition of opiates to be used as a first drug in the pain management of short term pain would address a lot of the concerns about preventable addiction.

BTW - it would also benefit that research paper to break out the data by chronic and non-chronic pain.

I think that there is a genetic component involved in the addiction. I am a cancer patient and had been on OxyContin and oxycodone for +4 years. Once I realized that the opioids were making me an aggressive asshole, I went a reduction schedule and stopping completely within 60 days. I had zero withdrawal symptoms. Now I manage with over the counter pain drugs.

I tend to think you're right, though your example is actually what's supposed to happen for anyone, regardless of genetics. Addictions tend to get "out of the system" in about 72 hours for most people. At least the physical dependency part. The psychological dependency can linger for years, and is often what drives addicts back to their drug(s) of choice.

But a slow tapering of addictive medication over 2 months should produce no withdrawal symptoms and be done with a minimum of difficulty, since it provides a much longer weening period for the body, and the mind. So, as I said, your experience is what's supposed to happen.

THAT SAID, the tendency to revert back to an addictive drug, I believe, depends on genetics to a large extent. Alcoholics, for example, have to have a genetic component to their addiction that increases the physical dependency. Hence why it's called a "disease", otherwise it would be a syndrome. Some folks can't be trusted to drink because they develop a strong physical dependency to any level of alcohol more or less immediately. Others can drink heavily for years, decide to stop "cold turkey" and suffer no adverse consequences because their bodies never developed a physical dependence.

Some things to consider are what we're discovering with respect to physiology and our genetic uniqueness. The our biome plays a huge part in how we process our environment, from food, medication, drink and the "germs" we come in contact with. Between the two, making judgements about "people" in general and applying them to the individual isn't a very sound approach since no one will fit the "average" in all respects. As they say, they can come close, but no cigar, and we can not be certain that an "average approach" to dealing with their specific issue will work for them.

Personally, I see the current "one size fits all" approach in medicine with respect to medications and prescriptions (everyone getting basically the same amount at the same frequency regardless of their age, weight, metabolism, gender, race and a host of other things known to impact the absorption of medications) going the way of the dodo bird. As we get better and interpreting the genome, and the biome, we will begin to make these correlations, and much better link them to causes and effects. I expect, assuming we survive that long, that people will look back on medicine today much like Dr. McCoy of ST-TOS did in the 4th ST movie "Journey Home".

Take a pill and grow a new kidney? Sure. No reason to think that can't be done someday. But I expect it would take more than simply pulling a pill out of a med kit and handing it to someone in passing for that to come about.

It seems to me like you're particularly sensitive to the effects of opiods. Everyone's body chemistry is different. In my case, I was originally on 80mg of Oxycontin twice a day after my bout with cancer, but the only effects other than dulling the pain was some drowsiness/lack of energy. I've never experienced the euphoria you've described (though the IV hydromorphone they gave me in the hospital a couple times came close), despite nearly a decade of being on opiods. I'm currently down to 10mg Oxycontin once a day, with Percocet for breakthrough pain, and I'm looking into dropping Oxycontin altogether. Maybe I'm just on the other extreme of the spectrum. I've always had high drug tolerance, even as a kid, medicines that purported drowsiness like Nyquil just bounced off me.

My theory is probably wrong but it was something a long the lines of;

If you're not in pain and take a pill, then you would get the high from it. Because there's no pain to treat.

So if you took the pill when you did have pain, and depending on the amount of pain and strength of pill, it would then treat the pain first, before giving you the high.

No, your theory is absolutely correct, based on solidly respected past studies. People who are given an appropriate dose for the amount/type of pain they're in won't experience an emotional high. It's when people take a higher dose than they actually need that it starts to affect their emotional state.

FWIW I've fallen into both groups in the past. In the one case, the oxycontin I was given to use at home a week after abdominal surgery was the right dose for the first few days, then started getting me high. In the other, I was on an extremely strong (but unchanging) Fentanyl patch for a decade for my spinal defects without any emotional impact.

What does have an emotional impact is knowing that my renal failure was on 'pause' for 15 years until I was forced to start tapering the Fentanyl and started 'snacking' on NSAIDs to compensate. Because a minuscule chance of dying peacefully in my sleep from a patch-controlled opiate I'd been thriving on for years is somehow far worse than a definite drawn-out painful death from kidney failure (given I suspect I won't be given a replacement when it's time).[Edit to add: most of that last sentence was sarcasm, just to be clear.]

When I crushed my knee and split my tibia in two, I was on fairly heavy opioids for about three months (morphine, OxyContin, tramadol). They were good for the pain but I never experienced any particular need/enjoyment of them, even when my doses were insanely high.

Eventually, I decided I just didn't like the mental fuzziness involved (nothing terrible - I started working from home a couple of days after the initial surgery and never really stopped), so I quit over a weekend. Now *that's* a stupid idea - I didn't discuss it with my doctor and I had no idea how dangerous it was to do so. Worst weekend of my life (even worse than the injury), but I was through the worst by Monday and never took another pill.

I always wonder whether it is a quirk of biology (although I come from a long line of alcoholics, so you'd think addictive behavior would be a given) that gets so many people hooked so quickly or if that many people have such awful lives that Oxy is that alluring. I feel for them - and hope that we figure out non-addictive effective pain relief.

It's easy for someone on the outside to say don't prescribe for chronic pain. So the alternative for some people, such as being bedridden for example is now acceptable? In America the spigot is always cranked way up or completely shut off. I've never seen policy so absent of moderation or middle ground.

I'd like to see the diagnoses for greater than 10 day prescriptions. Did those people have a potentially chronic condition and that lead to long-term use?

I have neuropathy from chemotherapy, and I was in terrible pain for 12 years due to being under-medicated. I would have fallen into the long-term user category. But the solution for me wasn't opioid reduction, but switching to extended release morphine. The unintended consequence of all these crackdowns is people with moderate to severe chronic pain being undermedicated, while doing nothing to stop addiction.

Doctors have a role in not prescribing opioids willy-nilly, but to claim that opioids shouldn't be used in chronic conditions is absurd.

This. I've tried really hard to use alternative meds and nothing works except Vicodin/Norco. OTC, Rx (Percocet, Tylenol 4, Oxycontin), nothing works like Norco does. I can take half a dose one day and not need it for weeks. I'm lucky not to have any addiction to the stuff. But getting it is becoming very difficult even though 1) it works 3) other drugs don't 3) I'm low risk.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

Then what are we supposed to do instead? die?I have Ehlers Danlos Syndrome and live in constant pain. Without painkillers I regularly cannot sleep for multiple nights in a row due to pain. There is only two solutions, pain relief or death.I choose pain relief, even though it could cost me in terms of health in later life.Without it I have no later life, so what's the difference?

But the authors did note that 10 percent of patients got tramadol, which is considered a relatively safe opioid. So this may hint that some intentional prescriptions for chronic pain is going on.

I hear the withdrawal from tramadol is pretty nasty as well, these also come in a long acting so I'm wondering why it's singled out as it is?

Because it's intentionally prescribed for chronic pain, and if a person is being treated for chronic pain it's not a surprise to find out they're still being treated a year later.

This is very true, I have been on it for 10 plus years for chronic pain and its is addictive. You take it to dull the pain and after a few days of taking it you quickly notice how it starts becoming less effective (It dull the pain less and for less time too) At that point you are left with a few choices, you ask for a dose increase next time you see the Doctor or up the dose a bit on your own. Those are very problematic for obvious reasons and dangerous because its easy to fall on a loop yet it is so easy to slip. In my case I learned to only use it as a last resort for when the pain is bad enough to interfere with daily activities and not for more than a few days straight which means being under-medicated. I'm not going to lie and say that the temptation isn't a problem, it is and it becomes ever present but for me other options haven't been effective. Pain can definitely cloud judgement and I suspect that using anything stronger like (oxicontin or vicodin) could quickly overwhelm such attempts at restraint for most and make you into an addict.

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

It makes the pain go away, ..Actually at first it actually hurts, if injected it spreads out in a wave of searing heat followed closely behind by a wave of glorious comforting coolness ( generally these race each others to your "special parts") then there's the nausea .. if you ever had "bed flips" when getting way too drunk as a kid its kinda like that.. but it keeps going on. Soon you get used to it and it just becomes a floaty sensation, but the nausea will come back if you move so lying down is reconmended. .. and not eating. You won't want to eat and your body really won"t deal with solid food very well at all - this is why ice cream is so popular.

In fact lying in bed being feed intravenously is likely the best way to do it, its how I first encountered it. And it actually works. All the pain actually goes away, or at least receeds. You might be aware of it if its something very traumatic but it doesn't really matter anymore.

And I mean all the pains, even the pains you've had so long you never even noticed them. Like the pain of the blood flowing thru your veins or the air scraping at your skin.

And when that pain goes away it feels really good, once you get over the nausia and not being able to move very well, you feel really comfortable lying there where ever there is. Your brain not having to deal with with all those little aches and pains can really really focus on how good you feel, and on that wonderful comfortable cloud you can day dream these amazing fantastic things that are so great it really doesn't matter that you can't remember what they were minutes later.

But then ... when the drug goes away (and it always goes away) all those pains come back, not just whatever injury or trauma that started you off on it but all those other pains, the little ones that you never noticed before but now feel excruciating.

Like did you know that growing hair is painful? All the hair all over your body is growing all the time and it itches and aches when it does so but it been that way thru out your life and you just kinda got used to it, it was a constant and the brain generally ignores things that are consistent and only perceives the things that change.

Well now that you didn't feel it for awhile you can't help but notice when it comes back... and its unbearable. Eventually you'll get used to it again but it'll take time, so much time, and even then your now aware of it. You'll know growing hair actually hurts and you'll know there's a way to make that pain go away.

There's a way to make all the pain go away, and its so easy, so simple .. you just have to take another fix. Just one more and everything will be nice again. For awhile.

Well thats opioids anyway ..Other drugs are different.

Acid is like replacing you brain with a power tool, your mental scissors become a superpowered chainsaw. Just be careful where you put it. E is like the care bears are real and love really is the most powerful and wonderful thing in the universe.Mda is like those care bears are actually fat biker furries with soiled fur and the world is a sex dungeon but your ok with that. (A useful mantra here is look don't touch) Mescaline is like doing champagne and acid with Noel Coward.Mushrooms are like .. damn thats a hard one .. mushrooms are a mess, just make sure you can go somewhere safe outside then you'll be ok. Peyote .. well. .. its all of the above plus about 52 other things .. and allot of puking and some pretty horrible gas Coke and speed .. well we all know what those are like, coke is like what you imagine it would be like to be Tom Cruise, speed is what it probably would actually be like.

I just count my lucky stars I don't have physical pain like some people have the bad fortune to have. I have headaches and they stopped after taking an antidepressant. They were really bad migraines. I wouldn't want ot live if I had to go back to that.

Too many doctors are forgetting that people are taking these opioids primarily for ACTUAL pain. Just yanking people off the medication or drastically reducing dosage with no form of dependence assistance is only making the problem worse and increasing suffering.

Forty or fifty or a hundred bucks per office visit, uncovered by insurance, is a pretty solid discouragement for follow up visits, especially when they need to happen all within just a few weeks.

I'm not saying your wrong - there's obviously something very wrong with patient care here - but a part of that problem rests with the stupid way we approach health care in the US by allowing profit to dictate what's delivered, rather than dictating based on best care practices.

as the pharma industry seeks to mitigate its own loss of pain control (aka dwindling profits, sacking employees, etc), it falls into a habitual dependency on finding ways to preserve the customers base it 'cares about'. constant media advertisements with claims of the very pain free ease of life that has become the popular crutch for anyone with the slightest of discomfort, must be advanced, even to create a whole customer base unable to withstand even a hint of natural injury.

all the numbers, studies, political support and feeble whining by the millions (with help from "legal consultations" ) will not alter the basic meanings of 'no pain, no gain". most therapy after any real crisis involves support for the natural regeneration of the body AND the preserving the psychological endurance that is needed to continue a healing regimen.

add in the loads of people that are fully hooked that rave to others about how GREAT it is to have drugs, and the issues become socially acceptable.

simple chemical dependence is one thing, but promoting the use of any drug as a commonly acceptable behavior is another. (& not just these obviously addictive opiods)

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

You already know exactly what opiates feel like.Opiates stimulate the release of Dopamine, the "feel good" hormone. A small dose of dopamine is always running through your body and stimulates a general feeling of well being. On a vacation on a beach in the Bahamas, the body releases a little more and you feel really well. A medium dose of opiates can give you that feeling on a crazy Monday morning at the office.A dopamine spike feel like an intense euphoric pleasure, the kind your body gives as a reward for doing something *special*, like going for that first kiss or winning Olympic Gold. A high dose of opiates can induce that feeling without you ever moving your butt of the couch

Sorry but no.

While in popular imagination and often in the press dopamine is a pleasure hormone the actual current science is not that at all.

First dopamine is used in multiple pathways in everything from physical movement to focusing attention to lactating .. why some treatments for schizophrenia which focus on the dopamine system can have the unfortunate side effect of excessive lactation even in men.

Second the particular dopamine pathway most often used in association with addiction is the mesolimbic, particularly the D2 receptors, and again its role here is NOT thought to be associated with pleasure.

It's more accurate to say its to do with an anticipation of a reward.

Its a pathway that's triggered to tell you this is a behavior that should be repeated because it might lead to a reward but isn't the actual reward at all. Its the want, the need, the monkey on your back. Many addicts will admit to actually feeling very little pleasure when triggering thier addiction, be it betting on a horse race or taking a hit of what ever is their drug of choice, in fact they may instantly feel bad, depressed or defeated by doing so but they still feel the need to repeat the trigger.

This is the painful,depressing irony and agony of addiction that those who are truely caught in don't actual recieve much pleasure from pursuing it but instead they are stuck in a behavior loop, the dopamine activates a pathway that tells them a certain substance must be consumed or a behavior inacted because that will lead to a reward, but no reward comes, but they still feel the "need" to repeat the same action in an attempt to gain that reward.

Dopamine in this instance is Not the reward. Its not a sensation of pleasure.

Instead its the advertisement, the huckster telling you that the reward is just waiting inside the tent you only need enter. Its the monkey on your back that won't leave you alone until you give it what it wants and when you do it doesn't matter the result, it doesn't matter if you feel good or bad, it just wants you to do it all over again.

I'd like to see the diagnoses for greater than 10 day prescriptions. Did those people have a potentially chronic condition and that lead to long-term use?

I have neuropathy from chemotherapy, and I was in terrible pain for 12 years due to being under-medicated. I would have fallen into the long-term user category. But the solution for me wasn't opioid reduction, but switching to extended release morphine. The unintended consequence of all these crackdowns is people with moderate to severe chronic pain being undermedicated, while doing nothing to stop addiction.

Doctors have a role in not prescribing opioids willy-nilly, but to claim that opioids shouldn't be used in chronic conditions is absurd.

This. I've tried really hard to use alternative meds and nothing works except Vicodin/Norco. OTC, Rx (Percocet, Tylenol 4, Oxycontin), nothing works like Norco does. I can take half a dose one day and not need it for weeks. I'm lucky not to have any addiction to the stuff. But getting it is becoming very difficult even though 1) it works 3) other drugs don't 3) I'm low risk.

This is why we can't have nice things.

each of us is an individual, drug laws (and many others) tend to be a crap shoot that attempts cover all bases in one swoop. once these issues end up in the hands of politicians, lawyers and media, all sense of reality (and fairness) seems to vanish.

Just use cannibanoids. They're safer, work far, FAR better than any opioid man ever created, and are in no way addictive.

Plus, they are natural.

I'm not disagreeing with your conclusion, but opium is just as natural.

So is botox, rabies, tsetse fly, gangrene and crude oil. Natural only makes sense as a universal positive if you believe the world was made specifically for our benifit. That all things were designed to suit our needs and desires .. and clearly they werent.

I can corroborate that most people don't know what a 10 on the pain scale is. If you've never passed out from pain, only to be woken up by someone screaming, then after a few minutes the realization pushes it's way through the haze of pain that you're the one screaming, you've never experienced true pain. If you're able to formulate a coherent response to the question "What's your pain level?", you're not at a 10. Your post struck a nerve (forgive the pun in bad taste, it's how I cope) with me because I know firsthand the kind of pain caused by a spinal tumor. I had an extremely rare form of cancerous tumor grow inside my fifth thoracic vertebra. Fortunately, surgery was an option for me, though it carried a very real risk of paralysis. By some miracle, I can still walk, albeit with a cane.

I once knew a guy who suffered from shingles. That must have been excruciating. In his case, it led to constant vomiting and blacking out just from the pain. But when he went to the hospital, they assumed he was an addict suffering from withdrawal, until one doctor figured it out. I can't even imagine that level of pain.

I've had shingles about a half dozen times.

Every one of my siblings had them before they were thirty, my grandmother died with/from them. My brother had a hernia from the resulting paralysis that then led to serious complication. One of my sisters was at risk to lose an eye. It seems to be a family trait.

As a kid I had extremely bad chickenpoxs, worse the local doctors had seen and was hospitalized, still have the scars. First had shingles when I was in my early twenties. Noticed a cigarette burn like mark on my back after my morning shower just figured it was work injury ( small burns were common) and ignored it, then on drive to work I just knew something was wrong so went to my boss to request a sick day and started to hysterically cry. It was bizarre, I literally was thinking clearly but when ever i tried to talk I just began to ball. My boss thought i was having a mental breakdown and i finally had to write down on paper that I was actually sick. By the time I got to hospital and into see the doctor i was feeling ok again and the first intern noticed nothing wrong with me, so I was thinking maybe I really did have a mental breakdown, then the floor chief came in and asked the intern to look at my back and describe what was on my back. The cigarette burn sized mark on my back had now grown to larger than a dinner plate. It had been just about two hours. Luckily the pain i've had from the repeated out breaks has been intense but not that bad, at least not compared to the other pains I've gone thru. Maybe a 7? At worse .. mostly 4-6, but I know it can be much much worse. The nerve damage is scarey, I have a patch on my back from that first outbreak that at least feels to me like the nerves have never fully regrown and theres the really frightening chance the pain can become permanent. Its mainly the creepy itchy insects eating at yir flesh sensation that leads and follows the scab as it works its way from your spine to your chest or belly working along the nerve endings exploding them that really gets to you.

The antivirials that you can take to treat an outbreak are brutal on your whole body, and I have had acute kidney failure a couple times I think as a result and the zoster vacine doesn't necessarily always prevent it recurring .. it has been about four years so here is hoping.

There was a suggested 'traditional chinese medicine' treatment one of the women i worked with during that first out break suggested. I had already recovered when it was suggested but even thou I got her discription translated twice to make sure I understood I've never been tempted. Basically it was a cockroach shirt, you can see why I needed multiple translations. You take about a thousand cockroaches and pound them flat into a papyrus like mat then you wear this directly on your skin like underwear night and day for two to three weeks. As shingles for me has never lasted more than four to five weeks I'm perfectly fine leaving that "treatment option" unexplored.

Wow, it is amazing to see all the short sighted people on here. Everytime you support the idea of making drugs harder to get you are helping cartels and hurting people in extreme pain every day. I was hit by an idiot on a cell phone two years ago and if it had not been for the opioids I would have hurt someone out of rage because I was hurting so bad. If a doctor had told me I could not have something for that pain I might have done something stupid. A doctor has no way of knowing who is in real pain and who is lying. When you crack down on pain meds you also crack down on car wreck victims. I had to go to three different doctors and spend thousands of dollars to "prove" I was in pain to get treatment. I finally found a doctor that actually had a machine that measures nerve damage and she said, "yes, you are in real pain" and gave me opioids for a little over three months. Once my pain was below a screaming level I worked myself off pain meds without any help from a doctor. These restrictions you are placing on drugs are only helping the cartels. If I had wanted to self treat my pain I easily could have for far less money than the doctors extracted from me. I spent 56,000.00 last year on medical expenses, and over half of that was spent trying to get a doctor not afraid to prescribe opioids. For every person on here calling for tighter restrictions on pain meds I wish you all to be in a situation where you need them and cannot get them. Only then will you learn the error of your ways. Tylenol 3 used to be over the counter, and still should be. Doctors are protecting their cartel with these scare tactics. If codeine were available without a doctor's prescription we wouldn'e have chemical weapons posing as drugs flooding into America (W18 Carfentanil). Your restrictions will only make drugs more powerful and dangerous. When someone uses Carfentanil as a weapon of mass destruction, it will be the doctor's and FDA's fault.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

Then what are we supposed to do instead? die?I have Ehlers Danlos Syndrome and live in constant pain. Without painkillers I regularly cannot sleep for multiple nights in a row due to pain. There is only two solutions, pain relief or death.I choose pain relief, even though it could cost me in terms of health in later life.Without it I have no later life, so what's the difference?

Treatment for Ehlers-Danlos syndrome is considered to be palliative care. The CDC guidelines explicitly lay this out as one of the situations where opioids should be considered for chronic pain treatment.

Typically I'd expect overly broad recommendations to be riddled with holes, but so far literally every argument people have brought up in this thread about this particular policy recommendation has been handled gracefully by the recommendation.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

That's easy for someone not living with severe or extreme daily pain to recommend to doctors. The problem is the CDC doesn't have any recommendations for cronic pain management. So basically they'd rather these people suffer and be unable to function.

The problem I have with this big anti-narcotic movement that's going on is that most people are so focused on the abusers they don't think about or acknowledge there are people in need being hurt by this. If they want to try and do something about the abusers, that's one thing, but treating everyone that's on long term pain medication as a junky or addict is wrong.

I've got a rare variation of an autoimmune diseases that doctors can't figure out. My local doctors had to refer me to an out of state, national specialist that researches this area 7 years ago. He has written medical journal articles about this condition, consulted doctors all over the world about it, and has even taken to naming this condition after me. I've had to take various IV medications and chemo over the past 7 years, and when we find one that works, my pain goes away and I stop taking pain medication, when my body adapts to the chemo or IV meds and they stop working then I end up with significant pain. At those points I have two options, either take pain medications and function, or be in so much pain that I can't function and end up in the ER multiple times a week, while on disability and risk losing my job (and my insurance with it). I work with a pain management clinic and we've tried all sorts of non-narcotic pain magnet treatments with no luck.

My point is the standpoint of the CDC is very naive and uncaring for people who are suffering and not all people on pain medication long term are junkies and addicts.

My point is the standpoint of the CDC is very naive and uncaring for people who are suffering and not all people on pain medication long term are junkies and addicts.

The CDC recommendations do foresee the use of opioids for chronic pain.But as a last resource and under close monitoring.

To me, it seems that a lot of of posters are reading this as "painkiller users == addicts" and feeling offended.This isn't about berating the users, not even the addicted users.

This is about the fact that opioid based painkillers are very addictive and that (some) US' doctors are prescribing them like candy.US represents about 80% of the world's opioid prescriptions. Canada and Western Europe, with represents a comparable number of people with a similar lifestyle, represents 15%.

And the study in this article attempts simply attempts to quantify how easy/frequent it is for patients to get addicted. And the answer seems to be: very, even more than people thought.

I noticed that a lot of the comments were from people who had never experienced severe excruciating pain nor had they taken the pain pills in question...i just wanted to add a dose of reality to the comments.

I've commented a lot in this section and I have had excruciating pain for many many years. I ended up on a high dose of opioid drugs, 180 pills a month, 1/2 fast acting 1/2 slow acting. I never abused my drugs and I was in severe debilitating pain that affected every aspect of my day.

I've had all the nerves in my neck from c-2 to c-6 cauterized with RFA needles 5 different times.

My reported pain levels on the meds was 6-8, now that I'm off the opioids (I take soma and cannabis) my pain is a 1-4 and usually in the 2-3 range. I'm functional and I can put it out of my mind.

If you take these pills for a long time that make your condition more painful. The very first physical WD symptoms is increased nerve sensitivity. This happens 6 hours after you take a pill that's supposed to last 8 hours but only works for 2. Coming off the pill makes it hurt more causing a feedback loop that's more complicated than simply increased tolerance.

I was told this a couple times and scoffed at it because the Dr didn't know how much I hurt. Then I tried kicking the meds.

My life has completely changed, everyone I interact with on a close level has noticed. I'm a different person than I was for the 8 years I was zombied out.

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

It's different for everyone. Prescription​ pain medications (Percocet, Oxymorphone, morphine​, Dilaudid, etc.) don't really give me a huge high. For me I go from being in tons of pain to not carrying about it. I can still feel whatever was causing the pain (for my condition it's severe swelling in the side of my face and neck, which puts pressure on the nerves in my face and even can cause Bell's Palsy), but it doesn't hurt as bad and I don't feel it as much.

But for me there isn't a huge rush or anything like that. With oral medications I don't feel any kind of rush or high. With IV medications (I've only had those in the hospital post surgery or in the ER, which unfortunately for me isn't infrequent) they'll give me a slight warm sensation for a few seconds and then all I feel is pain relief and maybe a little tired.

But like I said, it's different for everyone. I'm lucky in some ways, and at least if I have to live with this much pain (most days I'm at a 6+ and I have frequent flare-ups that are 9 or 10) I don't have bad reactions or much of a high from pain medications. When I'm only in a medium account if pain (say a 5 - 6 or lower) I don't even think about pain medications and the two times we found an IV medication that helped my underlying condition I just naturally tapered off the pain medications as my pain went down. But then after a year and a half for the first IV medication and two and a half for the second, my body adapted and they stopped working and my pain went way up and so did my use of pain medications.

My wife on the other hand has several back problems (degenerative disk disease, several herniated discs, etc.). Her back doctor had given her the smallest dose of lortab that they make (one small perception lasts her a year or two as she rarely takes them) and she cuts them in half. A half pill has her acting loopy, saying things she normally wouldn't (she's usually quiet, shy, and more reserved), and things like that. Because of this and because she is someone who always has to be in control she hates taking them and will only do so if she in extreme pain.

That's what makes this so complicated, for some people these medications are extremely effective and without them they wouldn't function and other people they make them high with even a small dose. And so am overly simplistic take on it, like the CDC has done, where no one in cronic pain but not terminal should take pain medications is horrible, uncaring, and extremely unfair to those who are suffering but may not need to.

I think that there is a genetic component involved in the addiction. I am a cancer patient and had been on OxyContin and oxycodone for +4 years. Once I realized that the opioids were making me an aggressive asshole, I went a reduction schedule and stopping completely within 60 days. I had zero withdrawal symptoms. Now I manage with over the counter pain drugs.

I tend to think you're right, though your example is actually what's supposed to happen for anyone, regardless of genetics. Addictions tend to get "out of the system" in about 72 hours for most people. At least the physical dependency part. The psychological dependency can linger for years, and is often what drives addicts back to their drug(s) of choice.

WD does not end after the initial "get it out of your system" intense symptoms.

That part of withdrawal is called acute withdrawal as it's the immediate reaction.

Check out "Post Acute Withdrawal Symptoms"

Basically your brain and body chemistry adjusts to the meds as it becomes the new normal. When you WD you change your brain and body chemistry and it freaks out for a while, you now have a chemical reaction in your brain/body as the chemical it's used to is gone. It takes some time for your systems to adjust to this new normal again.

Folks mention constipation, that goes away with time. Opioids slow your digestive system and your body makes up for it. When you take the drug away it's like pulling a plug out of the dike and the shit just flows through you. I carried baby wipes with me for 10 months having bile explosions 10-15 times a day. The nearest bathroom was always part of my mind.

Everyone reacts to PAWS a bit different but it's real.

Also kicking a 3x10mg percocet/day is not going to be like kicking 3x 80mg slow acting pills. 10mgs a day is a lot less than 240/day.

My point is the standpoint of the CDC is very naive and uncaring for people who are suffering and not all people on pain medication long term are junkies and addicts.

The CDC recommendations do foresee the use of opioids for chronic pain.But as a last resource and under close monitoring.

To me, it seems that a lot of of posters are reading this as "painkiller users == addicts" and feeling offended.This isn't about berating the users, not even the addicted users.

This is about the fact that opioid based painkillers are very addictive and that (some) US' doctors are prescribing them like candy.US represents about 80% of the world's opioid prescriptions. Canada and Western Europe, with represents a comparable number of people with a similar lifestyle, represents 15%.

And the study in this article attempts simply attempts to quantify how easy/frequent it is for patients to get addicted. And the answer seems to be: very, even more than people thought.

Yes, but the end result is that even people who are closely monitored by pain management doctors, like me (I have to see mine every 28 - 30 days and I'm given frequent drug screenings to make sure I'm taking what they give and nothing extra), are being negatively impacted. My doctor has told me they're getting pressure to prescribe less, even to people like me, and that the CDC has even sent them reconnections that people like me not be given narcotics at all. The doctor has even expressed concern that some of these recommendations could turn into regulations and that they're already seeing some changes in regulations.

My point is the standpoint of the CDC is very naive and uncaring for people who are suffering and not all people on pain medication long term are junkies and addicts.

The CDC recommendations do foresee the use of opioids for chronic pain.But as a last resource and under close monitoring.

To me, it seems that a lot of of posters are reading this as "painkiller users == addicts" and feeling offended.This isn't about berating the users, not even the addicted users.

This is about the fact that opioid based painkillers are very addictive and that (some) US' doctors are prescribing them like candy.US represents about 80% of the world's opioid prescriptions. Canada and Western Europe, with represents a comparable number of people with a similar lifestyle, represents 15%.

And the study in this article attempts simply attempts to quantify how easy/frequent it is for patients to get addicted. And the answer seems to be: very, even more than people thought.

Yes, but the end result is that even people who are closely monitored by pain management doctors, like me (I have to see mine every 28 - 30 days and I'm given frequent drug screenings to make sure I'm taking what they give and nothing extra), are being negatively impacted. My doctor has told me they're getting pressure to prescribe less, even to people like me, and that the CDC has even sent them reconnections that people like me not be given narcotics at all. The doctor has even expressed concern that some of these recommendations could turn into regulations and that they're already seeing some changes in regulations.

Have you heard of OIH at all? I don't want to be a broken record or anything, I didn't believe it at first either. Took me 2 months off the pills to have a positive result.

I got sick of the pain management crap.

*disclaimer, I now use cannabis for my pain management as it's legal in my state.

There is so much wrong here that a I don't know where to start. Probably worst is that they conflated addiction with dependence. The two are very different. They also have no reliable baseline. I don't know how they could possibly know that people who got prescriptions had no prior abuse. Even so, they cannot possibly know whether a person at t = 0 has already taken the drugs recreationally. This is selection bias. People who are experimenting with opioids are more likely to seek a prescription. And people who have been on opioids are, of course, more likely to have started them in the first place. Cause and effect logical flaw. And I didn't even look for minor errors. This is nothing more than a case of a faulty premise and misinterpretation or even misrepresentation of statistics. It is dangerous garbage, which will lead to more suffering and more fentanyl death.

There is so much wrong here that a I don't know where to start. Probably worst is that they conflated addiction with dependence. The two are very different. They also have no reliable baseline. I don't know how they could possibly know that people who got prescriptions had no prior abuse. Even so, they cannot possibly know whether a person at t = 0 has already taken the drugs recreationally. This is selection bias. People who are experimenting with opioids are more likely to seek a prescription. And people who have been on opioids are, of course, more likely to have started them in the first place. Cause and effect logical flaw. And I didn't even look for minor errors. This is nothing more than a case of a faulty premise and misinterpretation or even misrepresentation of statistics. It is dangerous garbage, which will lead to more suffering and more fentanyl death.

physical addiction comes with dependence, the only real difference between addiction and dependence is when we refer to the person with the physical addiction.

An Addict is addicted to a drug that gets them high while a dependent is addicted to a drug they are dependent on to get through their day to day life. The dependent doesn't abuse their meds but they are addicted nonetheless.

I think that there is a genetic component involved in the addiction. I am a cancer patient and had been on OxyContin and oxycodone for +4 years. Once I realized that the opioids were making me an aggressive asshole, I went a reduction schedule and stopping completely within 60 days. I had zero withdrawal symptoms. Now I manage with over the counter pain drugs.

I tend to think you're right, though your example is actually what's supposed to happen for anyone, regardless of genetics. Addictions tend to get "out of the system" in about 72 hours for most people. At least the physical dependency part. The psychological dependency can linger for years, and is often what drives addicts back to their drug(s) of choice.

But a slow tapering of addictive medication over 2 months should produce no withdrawal symptoms and be done with a minimum of difficulty, since it provides a much longer weening period for the body, and the mind. So, as I said, your experience is what's supposed to happen.

THAT SAID, the tendency to revert back to an addictive drug, I believe, depends on genetics to a large extent. Alcoholics, for example, have to have a genetic component to their addiction that increases the physical dependency. Hence why it's called a "disease", otherwise it would be a syndrome. Some folks can't be trusted to drink because they develop a strong physical dependency to any level of alcohol more or less immediately. Others can drink heavily for years, decide to stop "cold turkey" and suffer no adverse consequences because their bodies never developed a physical dependence.

Some things to consider are what we're discovering with respect to physiology and our genetic uniqueness. The our biome plays a huge part in how we process our environment, from food, medication, drink and the "germs" we come in contact with. Between the two, making judgements about "people" in general and applying them to the individual isn't a very sound approach since no one will fit the "average" in all respects. As they say, they can come close, but no cigar, and we can not be certain that an "average approach" to dealing with their specific issue will work for them.

Personally, I see the current "one size fits all" approach in medicine with respect to medications and prescriptions (everyone getting basically the same amount at the same frequency regardless of their age, weight, metabolism, gender, race and a host of other things known to impact the absorption of medications) going the way of the dodo bird. As we get better and interpreting the genome, and the biome, we will begin to make these correlations, and much better link them to causes and effects. I expect, assuming we survive that long, that people will look back on medicine today much like Dr. McCoy of ST-TOS did in the 4th ST movie "Journey Home".

Take a pill and grow a new kidney? Sure. No reason to think that can't be done someday. But I expect it would take more than simply pulling a pill out of a med kit and handing it to someone in passing for that to come about.

It'd take at least a few passes with a tricorder first.

Wrote a long reply citing various sources disputing your statement " Alcoholics, for example, have to have a genetic component to their addiction that increases the physical dependency. Hence why it's called a "disease", otherwise it would be a syndrome." And then I timed out of the site and lost it all.Its too long to repeat. So just quick bullet points First person to promote the idea alcholism is a disease (in america there was a dr Thomas Trotter in scotland and it was drunkenness as alcholism wasn't a word yet) was in the 1800 Dr. Benjamin Rush. He believed those who drank too much alcohol were diseased and used the idea to promote his prohibitionist political platform. He also believed that dishonesty, political dissention and being of African-American descent were diseases. Then in the mid 1950 E.M. Jellinek published The Disease Concept of Alcoholism which was based on a study funded by Marty Mann a top leader of AA and R. Brinkley Smithers founder of NIAAA. This study was basically 150 self reported surveys of AA members hand picked by Marty Mann of which about a third were then edited out of the results for pr reasons and while widely diseminated was also widely panned as being of "unscientific status" and containing "dubiously scientific data" but it achieved it purpose and the AMA first classified alcoholism as an illness in the 50s and a disease in the 60s hearby fulfilling R. Brinkley Smithers goal of allowing his string of treatment centers to access the funds of medical insurance. The study was so bad that E.M. Jellinek, who later did respectable work on placebos, was asked by Yale university to publically refute it, which he did. Since there has plenty of studies since that line up on both sides and the idea is still hotly debated in medical research labs, mostly behind closed doors, but the alcoholism is a disease publicity Campaign has won the public debate with roughly 90% of the public in polling responding that they believe it is.

But (besides as a scotman of who's family on his father side has no males who have ever reached sixty, at least in the last half dozen generations, almost all of those died drunk if not directly because of drinking so I know about predispositions towards alcoholism would still,highly caution you on assumptions of proof of genetic causation of behaviors, you don't want to be a Dr Rush) I would definitely state that is not why Alcoholism is called a disease rather than a syndrome, a trait, a behavior, or a choice.

Rather the reason its now commonly referred to as a disease are primarily political, social and not inconsiderably financial.

Fortunately despite breaking my wrists 3 times (one of which required 6 months rehabilitation and has resulted in restricted movement) I have never needed long term pain relief. However, it does seem to me that we need to be cleverer in prescribing pain relief. In order to minimise effects rather than prescribing one type of drug (or class) for a prolonged time (anything over a couple of weeks) doctors should ensure that patients cycle through different drugs (or classes of drug) almost on a weekly basis. Also they should use the weakest drugs necessary to achieve the pain relief not the strongest - although I appreciate that varies from person to person (aspirin has no noticeable effect on me, strong paracetamol does)

My point is the standpoint of the CDC is very naive and uncaring for people who are suffering and not all people on pain medication long term are junkies and addicts.

The CDC recommendations do foresee the use of opioids for chronic pain.But as a last resource and under close monitoring.

To me, it seems that a lot of of posters are reading this as "painkiller users == addicts" and feeling offended.This isn't about berating the users, not even the addicted users.

This is about the fact that opioid based painkillers are very addictive and that (some) US' doctors are prescribing them like candy.US represents about 80% of the world's opioid prescriptions. Canada and Western Europe, with represents a comparable number of people with a similar lifestyle, represents 15%.

And the study in this article attempts simply attempts to quantify how easy/frequent it is for patients to get addicted. And the answer seems to be: very, even more than people thought.

Yes, but the end result is that even people who are closely monitored by pain management doctors, like me (I have to see mine every 28 - 30 days and I'm given frequent drug screenings to make sure I'm taking what they give and nothing extra), are being negatively impacted. My doctor has told me they're getting pressure to prescribe less, even to people like me, and that the CDC has even sent them reconnections that people like me not be given narcotics at all. The doctor has even expressed concern that some of these recommendations could turn into regulations and that they're already seeing some changes in regulations.

Have you heard of OIH at all? I don't want to be a broken record or anything, I didn't believe it at first either. Took me 2 months off the pills to have a positive result.

I got sick of the pain management crap.

*disclaimer, I now use cannabis for my pain management as it's legal in my state.

I have, and about once a year I'll get fed up with my condition and decide to quit taking them cold turkey, but after a few days with them out of my system I'll end up with a flare-up that is bad enough that I'll take them or else end up in the ER. During those days I'll end up ornery and won't be very functional. My wife will notice and ask what's going on. When I tell her that I'm fed up with my condition and bit taking pain meds she just shakes her head. When I'm back on them and in a lot less pain, I function more and I'm back to my pleasant, happy self.

My doctors have also found some​ chemo meds that have worked for a year or two, and on one of them the first dose lasted almost 6 months and add it started working (it kicked in over about 6 weeks) I naturally tapered off the pain meds as my pain went away, but about 5 months after the first dose my pain came back and I started taking more as my pain went up. The problem was I could only get that chemo every 6 months and each dose took longer to kick in and wore off quicker, until it took 2.5 months to kick in and would wear off 3 or 4 weeks after that. So, I have gone off of them.

I'm not saying that OIH isn't a real thing and doesn't affect me. I'm saying that even given it, I'm still better off taking my pain medication. I'm also not trying to say this is true for everyone. What I'm saying is this is a complex issue, and that while I agree pain medications should be avoided if possible, they are still better than living in extreme pain with no end in sight and shouldn't be removed as a possible option.

I can't imagine having to go back to living every day in 9 - 10 on the pain scale with no hope for a change and unable to get out of bed due to pain. I don't personally believe in suicide, but that experience nearly changed my mind.